Your Humble Scribe

Friday, May 25, 2012

Pericarditis, and you

The pericardium is a double-walled sack around your heart. It is slicker than greased weasel snot, and is usually lubricated with a small amount of pericardial fluid. During the normal course of your day, the two membranes and the cardiac muscle slip past each other with nary a care in the world.

Other times ...

Several nights ago -- just before the "Hey, I just broke my hand on a critter" day, matter-of-fact -- I was yanked out of a sound night's sleep by the somewhat unique sensation of getting hammered through my chest to just under my left shoulder blade by what can be best described as an ice-cream head-ache with troll genetics, a lead slapper, and a grudge.

I staggered out of bed, into the bathroom and assessed the situation: There was chest pain, but it didn't have a "heavy" sensation; it got worse if I bent forward, laid on my back, or took a deep breath; I was sweating, but not clammy; and there was a feeling of general pissed-off, rather than fatalism or anything else.

Ergo, I thought to my self, pleurisy. Again.

So, I downed two naproxen sodium and held my breath in the recliner until the pain subsided enough that I could doze back off.

Last April, AEPilotJim was visiting, and we were enjoying something dead and not very burned at a local eatery when this exact same thing happened. At that time, Herself and AEPilotJim rushed me to the ER where it was determined (after one metric butt-ton of very expensive tests) that the sensation I was not enjoying was not a heart-attack, but "probably" pleurisy.

I was given a prescription for steroid horse-pills, non-OTC naproxen sodium, and a anti-biotic; and advised to take a couple of days off.

While the pain did go away, every once in a while since then I've been getting a somewhat-less-agonizing repeat -- each of which has been diagnosed as "chest-wall spasms" or "esophaegeal spasms" or other ailments which seem to be primarily treated by a regular dose of anti-anxiety meds.

Well, bugger that for a lark. I figured the pleurisy had left a weak spot over a lung, and each time I'd take naproxen for a week, it'd get better, and voila!

Fast forward to now. AEPilotJim had arrived in town for a visit a couple of days ago. As is tradition, we went to the same eatery, and the next day at the office I was assigned to work a rather warm control room. About 90 minutes into my shift the nagging pain of my pleurisy episode had increased, but the alarming thing was the fact that it was slowly getting harder to breathe.

I gave myself the rest of the day off, and -- since my lady tends to fret about my health -- I decided I would go by Bugscuffle Clinic & Bait and have them take a picture of my lungs so I could reassure her that I wasn't having pneumonia. Again.

"Hello!" chirped the alarmingly cheerful receptionist. I marshaled my thoughts -- there were so many ways that what I was about to say could go very bad, medically-speaking -- then said, very gently and with all of the confidence I could muster: "Yes. I've a touch of pleurisy. I've had it before. I just need a chest x-ray to make sure nothing dramatic is going on."

Low key, right?

So, I'm led back to a cubicle where a Nurse Practioner is already waiting, and the first question out of his mouth isn't so bad: "Soooo ... pleurisy?"

"Yep," sayeth I, "I've had it --" The next question cuts me off mid-speech, and I know I should have gone on home. "Sooo ... your chest is hurting?"

I look at the eager young eyes, and something in the back of my mind sighs, pulls a Migraine Salute and whispers, "Don't bother. The path from here is preordained", but I try anyway.

"Yes, I have chest pain, but it is positional. It is worse when I lie down or bend over. It gets worse when I breathe in, but exertion does not make it worse. I've had this exact same pain, in the exact same place, before and it was pleurisy," I look at another nurse who is busy pumping on my arm, "Look, my blood pressure is 120/76. I'm willing to bet large amounts of money that my pulse is strong and steady at between 60 to 80. I am NOT having a heart attack."

"You are over forty, past history of diabetes, hypertension and hyperlipidaemia?"

"Yes, but X plus Y plus Z doesn't necessarily equal 'Acute Myocardial Infarc', either. I just need a chest x-ray to make sure I've not got pneumonia and that my lungs are still where they should be, give me some NSAIDs and send me home."

He adopts the soothing tone instilled in nursing school and I know I'm screwed, "I checked your file, and you don't have a baseline EKG in there. That's something we like to maintain, so why don't we go ahead and knock that out while you're here. Okay?"

I figure, what the hell, get the EKG out of the way, only a little bit of extra time, then home, right?

When the tech ran out of the EKG room so fast that her crocs were smoking, EKG strip clenched in one paw, I started to get peevish.

Of course, this was followed by the NP bounding into the room, EKG clenched in one paw like the Six Lost Commandments, and announcing, "You! Are having a heart attack!"

I heroically resisted saying the first thing that came to mind, instead stating -- rather firmly, I admit -- "No. I'm not."

"You are! Right now! Here, swallow this aspirin! Good, slip this under your tongue! Now, see this EKG? This part! You don't understand it, but trust me! This is your heart dying! Denial does not change fact!"

I glare at him, grab me cell-phone and call Chris, "Chris, Bugscuffle Clinic & Bait is saying I'm having a heart attack ..." and then that little voice in the back of my head says, "Oy. Sub-lingual? That's nitro. But my blood pressure was 120/ ... Weasels! Popcorn! Bretty putterflippthbb, ppthhbb, ppthbb*"

I wake up several minutes later, in screaming agony because I'm flat on my back, and the first thing I see are the softball-sized eyes of a good friend in his Bugscuffle PD uniform. Then I notice that the entire room is full of Bugscuffle Volunteer Firemen. And that Nurse Practioner is rubbing two cardioverter paddles together with the sort of beatific look on his face that tells me that I have just made all that schooling, testing, time and money worthwhile.

I roll to one side, then push myself to a sitting position BECAUSE THE PAIN FROM THE PLEURISY IS BLOODY WELL KILLING ME, and snarl, "I am not having a sodding heart attack, so don't even think of coming near me with that ... oh, bugger. You called the ambulance, didn't you?"

Sure enough, wading through the horde of First Responders with a reassuring air of humour and cynicism is a set of paramedics from Big City. One of them kneels next to me, "Hey, sport. How are you doing?"

I look at him, "How do you feel about listening to your patients?"

"Makes my job easier."

"Condescension?"

"Pisses me right off."

"We're going to get along just fine. I have chest pain. It is positional, and gets worse when I take a deep breath, or lay flat on my back. I've had this exact pain, in this exact location before, and it was pleurisy. I am not in denial, and I am NOT having a heart attack."

"Nope. You're not. But your EKG isn't right, either. Let's go ahead and take you into Big City Memorial, let someone with a lot of letters after their name make sure this isn't going to go south on you."

I take a breath and he leans forward, and says, sotto voce, "I broke my Edison cherry a long time ago, and I'm not jonesing for a chance to kink your curlies. Be safer in the Big White Taxi."

25 comments:

I get pleurisy from time to time, and it's exactly as you describe. One doctor told me I had gas, and another put had me do the treadmill-cardiac-ultrasound test. Shocker - my heart was fine, but my chest still hurt. I haven't had an episode worth noting since I've been on a therapeutic dose of ibuprofen.

Glad you got an EMT with some sense. I look forward to reading the rest.

Well written, good story. Looking forward to read about the outcome.Not trying to say you were in denial...but I recenlty came across Paul, who also didn't think he had a heart attack...structured guidelines for patients presenting with chest pain have been implemented for a reason...

It takes a special kind of personality to write an honest, funny article about a life threatening event. I've admired your writing for a long time and now also admire your sense of self and why laughter is the best medicine.

I think you need to start carrying lollipops. The nice PA at the Dr's office tried to tell me I was having a MI, I gave him a Lolli and told him "Nope, not unless you don't get these things off of me, I have an Arrhythmia" Sent to specialist Yup I have an Arrhythmia. But giving them a lolli knocks them off their stride a bit.

And PLEASE get rid of the word Verification. It looks like I'm trying to read greek or russian in the cyrillic alphabet

Oof. When you're feeling better, run on back to the clinic and start gleefully fondling your taser, then tell the tech that if they ever again give you nitro when it's not indicated, you'll consider your own version of Edison Medicine.

Lawdog...Take a look in your lady's eyes and honestly tell her that she shouldn't worry, shouldn't care - you're just fine...Being dead is no excuse...I teach death and dying to cops, ambulance drivers and other storm trackers...one of the things I ask them to do is write their own epitaphs...mine will say - Damn, another learning experience...get better, live long and prosper.Le Conteur

Glad it was/ is survivable and that you have not throttled the PA (yet). Um, how to be delicate about this . . . Have you inquired as to if your folks got the extended care warranty on you? Not that I'm saying anything about passage of years and mileage, no. I would never be so crass.

Woke up in the middle of the night when I was about 13...had a dream I had fallen off a ski lift(never seen snow before, let alone ski) and had broken every rib. Quick trip to the ER and a dx of pleurisy. Worst pain I had ever felt.

I have a pinched nerve in my back right betwixt my shoulder blades. When I move a certain way, it clinches and mimics a number of symptoms that makes medics want to haul me off. I've enough EKGs on file in a number of places for baselines.

Just sitting still in a recliner usually works in a half-hour or so. Like you, I've learned to be very careful how I describe the symptoms...jaw and chest main, heavy feeling, etc.

I've had pleurisy. Mine, however, was on the other side of my torso. It felt like I had a knife in my back. I thought I'd thrown my back out during an Olympic-like stomach flu event, which turned out to be very confused white blood cells. I had a severe case of bilateral pneumonia. IV antibiotics, steroids, and anti-inflammatories were needed to kick that to the curb. I freak out over back pain in the general area in which I had the pleurisy, because the last thing I need is pneumonia and complications again.

Having read post two before post one, I'm glad it's NOT an AMI, and that you seem to have found a good doc who has figured it out and is actually treating the problem instead of the the symptoms.

The best description I can give for my experience with pleurisy was an unanesthetized mastectomy by Freddie Kruger, so anyone suffering from it or something mimicing it has my deepest sympathy. Pleurisy and pericarditis would seem to be similar, it's just whether it's the sac around the heart or the lung. As for nitro, I was given it once for chest pain that turned out to be stress and a benign arrhythmia. I don't think I ever want it again, even if I *am* having an AMI; it took almost longer to recover from the severe nitro headache and nausea than the original chest discomfort.

Means you have gotten over the desire to use electricity on every chest that might have an electrical conduction issue.

NP's ain't PA's, please don't confuse us. While there are plenty of idiots of both styles out there, most PA's had quite a bit of medical background before they became PA's, and thus have some experience at telling the difference between sick people and SICK people.